How to (NOT) Treat Fevers Properly – a.k.a. the Most Common Mistake When Visiting the Emergency Room

Dear parents,

Every healthy child has a fever from time to time. Yet many parents feel unsure or frightened when their child has a fever. But what exactly is a fever, what can you do about it, and what is important?

Relax.

If you are anxious, your child won't be able to relax and tolerate the fever well. First, make sure your child doesn't show any signs that require urgent medical attention (see the MANUAL FOR ASSESSING SEVERITY OF MEDICAL CONDITION).

Be present.

See febrile illnesses as an opportunity to nurture your relationship. Candlelight, songs, fairy tales, or simply your calm presence can help. Electronic media are not a substitute and should be kept to a minimum—if used at all.

Stay positive.

Science has shown: people with a positive mindset live longer and healthier lives. Be a good example to your child and stay calm and positive in the face of any challenge or setback. Always ask: "What could this be good for?" What initially seems like a problem often turns out to be the start of something good.

Welcome the fever.

Fever is a friend—it fights infections and supports the development of the immune system.

Warmth first!

Make sure your child is warm as the fever rises. This way, the body needs less energy to generate a fever, there will be less shivering and discomfort, and in some children it may even help prevent febrile seizures.

Some children feel quite unwell at first.

Offer fluids (preferably warm), comfort them, tell short made-up stories or rhymes, sing or hum. These unpleasant feelings usually don't last long. If you cannot calm the child or they appear very unwell, you must seek medical attention. While fever often causes headaches in adults (which may require pain relief), in children, pain medication is rarely needed (see MANUAL FOR ASSESSING SEVERITY OF MEDICAL CONDITION).

Let the fever do its job.

Fever itself is not dangerous; the potential danger lies in the underlying illness the child is reacting to. Once you and/or your doctor are confident that nothing serious is going on, focus on making the experience as pleasant as possible for everyone involved. This does not have to include fever-reducing medication: in otherwise healthy children, there is no temperature at which you must automatically give fever medication. In a calm and safe environment, most children tolerate high fevers without pain.

If the child is suffering, try natural methods, such as:

• Thin lemon slices on the soles of the feet,

• Thin warm moist cloths on the lower legs (many parents use cold compresses, but cold causes discomfort and rebound effects; warm moist cloths are not shocking to the child and still remove heat effectively through evaporation).

Then gently cool down.

When the child feels warmth all the way to the hands and feet, and starts sweating after several hours of fever, you can gently remove some layers of blankets or clothes to keep the child comfortable—but still keep enough coverings so the child feels warmth down to hands and feet! In some countries, patients are kept warmly covered even in this stage to support sweating. The authors are not yet certain when this is beneficial and when it's not.

Drinking and eating.

In the initial phase (fever rising), the body has one goal: to raise the temperature! So don't expect your child to want to drink or eat much. Just provide warmth. Once the fever plateaus, offer small sips—preferably warm drinks (e.g., mild thyme, elderflower, or chamomile tea). Later, when the fever subsides, the child will likely be more open to drinking and even eating light foods, such as thin soups.

Show your doctor that you're informed about the positive effects of fever:

Many doctors prescribe antipyretics (like paracetamol and ibuprofen) even though they know that fever itself isn't dangerous—because they think parents are afraid of it. Let your doctor know that you understand fever is a beneficial response of the body.

Source:

https://warmuptofever.org/en/recommendations/

https://choosingwiselyitaly.org/en/raccomandazione-prof/do-not-treat-a-fever-systemically-unless-there-are-symptoms-of-discomfort-if-you-decide-to-treat-it-use-an-appropriate-dose-avoiding-combined-alternate-use-of-paracetamol-and-ibuprofen/

If you do need to give fever medication

(Most commonly due to pain—since these medications act both as antipyretics and analgesics)

There are two basic over-the-counter medications commonly used in childhood. Generic names are in ALL CAPS, brand names in parentheses:

• IBUPROFEN (Nurofen, Brufen, Ibalgin, MIG) – a non-steroidal anti-inflammatory drug (NSAID)

• PARACETAMOL (Paralen, Panadol)

Both are available as:

• Tablets

• Suppositories

• Syrups

Rules for measuring temperature

• Body temperature from 36°C to 37°C is normal

• 37°C to 38°C is elevated (called subfebrile, not yet a true fever)

• Above 38°C is fever

IMPORTANT:

There are no clear universal recommendations for automatically lowering a fever.

How to measure temperature?

Use contact thermometers—they're cheaper and more reliable (digital or alcohol-based).

Non-contact thermometers are inaccurate, unnecessarily expensive, and unreliable.

🧠 GOOD TO KNOW: For children under 1 year, measure temperature rectally using a digital thermometer with a flexible tip. Subtract 0.5°C from the measured value to get the actual body temperature.

When to see a doctor?

FOLLOW THE MANUAL - USE GOOGLE TRANSLATE OR CHAT GPT (CLICK HERE).

⚠️ NOTE: If the child has no obvious symptoms (cough, sore throat, runny nose, rash), you must bring a midstream urine sample to the doctor's office. For infants and toddlers, collect urine using a urine bag, which can be bought along with a sterile container at the pharmacy. Always wash the genital area with soap and rinse with water before collecting the sample.

Dosage principles

Ibuprofen can be given to children from 3 months of age for pain:

• Dose: 7.5 mg/kg of body weight every 6 hours

⚠️ For children under 30 kg: do not exceed 500 mg/day

• If dosing every 8 hours, you may give 10 mg/kg

• NEVER exceed a total of 30 mg/kg/24h

⚠️ DO NOT GIVE IBUPROFEN:

• During chickenpox (varicella)

• If the child is dehydrated — always monitor hydration carefully!

Paracetamol can be given from 2 months of age:

• Dose: 15 mg/kg every 6 hours (max 60 mg/kg/24h)

• In case of pain, you can alternate Ibuprofen and Paracetamol every 3 hours